Outside USA:
There is no network outside USA and you may have to
first pay and then get reimbursed from the insurance company by
filing a claim form. The doctor's office or local hospital has
choice to be paid by the patient or by the insurance company.
However, for larger expenses like hospitalization/surgery etc,
the insurance company will make arrangements for direct payment
to the provider.
Inside USA:
Reside Prime from Seven Corners participates in
Hygeia/First Health PPO Network.
When you go to the doctors in the network,
please mention that you have Hygeia/First Health PPO Network, as the doctor
sometimes may not be aware of Seven Corners or Reside Prime. When you go to the doctors and hospitals in the network, they will
take the insurance card and bill the insurance company directly. And they
will also charge only the Network Negotiated Fee (NNF) which is a discounted
fee in many cases.
When you go to the providers outside the network, you can
present the insurance card. Insurance card has all the information
doctor's office needs to bill the insurance company directly such as the certificate
number, claims filling address in US, toll-free number to call and verify the coverage.
But it still depends upon the doctor whether
to bill the insurance company directly or not. Even if the doctor accepts the card,
there is no network negotiated fee. If the doctor does not accept
the card, you have to first pay and then get reimbursement by filing a
Claim Form.
You can either use the claim form you receive in the mail along with the insurance
card or you can download the
Claim Form from this website.
Seven Corners will reimburse you usually within 4 weeks of they receiving the claim.
However, when there is hospitalization/surgery involved and the costs
are quite high to pay first, Seven Corners will make neccessary arrangements to pay the provider
directly. There is reduction of benefits of 20% when not using the network,
unless there are no providers within 20 miles radius.
All your claims will be handled by Seven Corners in USA. You never have to contact
the carrier, Lloyds, for any purpose whatsoever.
There is no network of providers for prescription drugs(medicines).
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